Abstract

Introduction: We previously documented 97 older-adult outpatients who “passed” the Mini-Mental State Exam (MMSE; cutoff = 26) despite evidence of moderate or severe memory impairment (i.e., Hopkins Verbal Learning Test-Revised (HVLT-R) delayed recall z ≤ −2; Lacy & Kaemmerer, 2012). We expanded this work by exploring whether patients exhibiting a similar magnitude of memory impairment on the HVLT-R performed differentially on the MMSE as a function of age and educational attainment. Method: We analyzed the MMSE and HVLT-R data of 300 consecutive outpatient memory center referrals (mean age = 78.54, SD = 7.28). After grouping patients by HVLT-R delayed recall performance (i.e., no impairment, mild [z ≤ −1.5], moderate [z ≤ −2], or severe [z ≤ −3]), we formed subgroups based on age and education (Group 1: age ≤ 79, education ≥ 16yrs; Group 2: age ≥ 80, education ≤ 15yrs) and conducted between-group analyses of MMSE performance using t-tests. Results: On HVLT-R delayed recall, 30 patients (10%) exhibited mild impairment, 71 (23.6%) exhibited moderate impairment, and 131 (43.6%) exhibited severe impairment. At each level of impairment, younger, more educated patients performed better on the MMSE than older, less educated patients, though these differences reached significance only among moderately memory-impaired patients, t(24) = −2.54, p = .018. Conclusion(s): In our study, older adult outpatients who were relatively younger with higher educational attainment were more likely to appear healthy on basic screening (i.e., MMSE) in spite of significant memory impairment. More in-depth memory testing may be especially necessary for the adequate screening of such patients.